Jimmy Carter's Cancer: How Doctors May Find Where It Started

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Former President Jimmy Carter has not revealed much about his
recent cancer diagnosis, but an important part of caring for
anyone with cancer is finding out where the disease started, so
that doctors can best treat it, experts say.

Yesterday, Carter
released a statement saying that during a recent liver
surgery, doctors discovered metastatic cancer. Metastatic means
cancer that has spread to other parts of the body from where it
started.

"I will be rearranging my schedule as necessary so I can undergo
treatment by physicians at Emory Healthcare," Carter said.

The former president did not say if his doctors know where his
cancer started, or how extensively the cancer had spread.

If doctors find metastatic cancer and don't know where it
started, there are several things they can look for to determine
the cancer's site of origin, said Dr. Moshim Kukar, an assistant
professor of surgical oncology at Roswell Park Cancer Institute
in Buffalo, New York, who has not treated Carter.

If doctors are able to take a biopsy of the tissue and look at it
under a microscope, certain features of the cells can reveal
where the cancer came from, Kukar said. Imaging of the site of a
cancer can also inform doctor's understanding of the cancer's
origin; for example, a tumor that starts in the liver looks very
different on a scan than a tumor that has spread to the liver
from the colon, Kukar said.

Doctors will also consider the organ in the body in which a
metastatic growth is found, because "certain tumors have a
predilection to go to one organ more than others," Kukar said.
"Depending on where the spread is, you can figure out where it
could have started."

For example, cancer that starts in the colon or other parts of
the gastrointestinal
tract commonly spreads to the liver, said Dr. Stephanie
Bernik, chief of surgical oncology at Lenox Hill Hospital in New
York City.

Doctors also take into account a patient's family history and his
or her symptoms when trying to figure out a cancer's site of
origin, Bernik said. "It's like putting the pieces of a puzzle
together," Bernik said. In Carter's family, several people have
had
pancreatic cancer — three of his siblings had it, and his
father died from the disease — so pancreatic cancer would be a
concern in his case, Bernik said. [ Why
Is Pancreatic Cancer So Deadly? ]

Finding out where a cancer started is very important because this
information guides a patient's treatment, as well as helps
determine the prognosis, Kukar said. Surgery is very rarely done
for patients with metastatic cancer, but the choice of
chemotherapy drugs and other treatments that may be done depend
on where the cancer originated, Kukar said.

For example,
colon cancer that spreads to the liver can be curable, so
patients with this diagnosis would be treated very aggressively,
Bernik said. On the other hand, pancreatic cancer that spreads to
the liver is usually not curable, and so treatments are geared
toward extending life in a meaningful way, Bernik said.

Carter said he will make a more complete public statement about
his diagnosis at a later time, possibly next week, when more
facts are known.